From Symptoms to Treatment

Multiple sclerosis (MS) is a complex and puzzling disease. Because each person is affected differently, it can be difficult to diagnose. Northwestern Medicine Neurologist Carolyn J. Bevan, MD answers the most frequently asked questions and discusses the active research being conducted in the field.

What Causes MS

MS is a disease in which the immune system attacks myelin, which is the protective coating of nerves in the brain and spinal cord. This disrupts nerve signals within the brain and to the body. Because each person is affected differently by the disease, it is often mistaken for other health issues.

There are different types of MS:

• Relapsing-remitting MS, the most common, is characterized by isolated episodes (or attacks) followed by periods of time where there is partial or complete recovery.
• Primary-progressive MS is a progressive worsening of symptoms over time, with no periods of recovery.
• Secondary-progressive MS occurs in some patients after many years of enduring relapsing-remitting MS. Relapses become less common and instead patients experience progressive worsening over time without periods of recovery.

Although there is a genetic component, MS is believed to be caused mostly by environmental factors. Dr. Bevan explains, “Viruses, gut bacteria, vitamin D deficiency and a lack of sunlight exposure, and smoking all seem to play important roles.”

While it is more commonly diagnosed in women between the ages of 20 and 50, MS can affect anyone from childhood to later in life. “Although it’s not the most common story, individuals can be diagnosed later in life. There’s a wide variation in when people become symptomatic,” says Dr. Bevan. 

Most Common Symptoms of MS

Symptoms of MS can vary widely from person to person, based on which areas of the nervous system are affected. Symptoms result from the destruction of myelin, which is then replaced with hardened patches that can impact the transmission of signals between your body and brain.

Dr. Bevan says, “Symptoms can be subtle and attributed to other things. Someone might brush it off like a pinched nerve or thinking they slept wrong.”

Common types of attacks, which are defined as neurologic symptoms lasting more than 24 hours attributable to inflammation in the brain or spinal cord, include:

• Loss of vision in one eye
• Double vision
• Trouble with balance and incoordination
• Weakness or change in sensation
• Issues with bladder or bowel movements
• Changes in memory, concentration or fatigue

When to See a Physician

“We want to be cautious before jumping to any conclusions,” Dr. Bevan explains. “If you experience ongoing symptoms that are not acute, you should mention them to your primary physician. You can discuss whether these symptoms could signal MS or could relate to another neurologic problem or unrelated concerns.”

However, if you or someone near you experiences sudden onset of severe neurologic symptoms, it’s important to call 911 or go to the emergency department to eliminate other possible causes, such as stroke.

Diagnosing MS

There is not a specific test for MS, so diagnosis can be difficult to make. The Northwestern Medicine Multiple Sclerosis Program team specializes in making the diagnosis through careful evaluation and exclusion of other mimics. After a clinical evaluation with detailed discussion of symptoms and a thorough neurological examination, if there is concern about MS, an MRI of the brain and spinal cord will be conducted. Though it’s not necessary for diagnosis, tests can be run on a sample of spinal fluid obtained through a spinal tap (or lumbar puncture) to obtain additional information. Blood tests can also help eliminate other possible causes of symptoms.

“At that point, if we are unsure, we will use more detailed diagnostics such as visual diagnostic testing or detailed neuropsychological evaluations to get more information,” says Dr. Bevan. “It’s important to be as specific as possible to get the right diagnosis.”

Treatment Options for MS

Although there is no cure for MS, once a diagnosis has been made, specialists can help individuals choose the right disease modifying therapy, manage their symptoms and improve quality of life. “Thirty years ago, we didn’t have any FDA approved treatment options. Now, there’s a long list, and it’s growing,” explains Dr. Bevan.

Treatment options vary based on the type of MS. Treatment can help patients recover after an attack, prevent MS relapses and manage ongoing symptoms. In addition to various medications, individuals may also benefit from physical therapy, diet and lifestyle modifications to help control their disease and manage their symptoms. Scientists are actively researching options for promoting remyelination and repair as well as therapy for progressive forms of MS.

“I encourage anyone with a diagnosis of multiple sclerosis to talk to their neurologist about disease-modifying therapies. There are also many treatments that can help with symptoms. Work with your neurologist on a comprehensive treatment plan to help you live your best life,” says Dr. Bevan. “It’s a very hopeful time with the growing number of disease-modifying therapies and ongoing research. There’s a lot of hope in the world of MS right now.”